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Posts Tagged ‘obesity

Parents In Denial About Their Children’s Weight Problems

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In a study of 104 children under treatment for type 2 diabetes at the Vanderbilt Eskind Pediatric Diabetes Clinic, the children and their parents were surveyed about their perceptions of the child’s weight, dietary and exercise practices, as well as barriers to improving diet and exercise habits.

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Quite often, both the children and their parents underestimated the child’s weight status.

“You could argue the first step for overcoming obesity is recognition,” said Russell Rothman, M.D., assistant professor of Internal Medicine and Pediatrics at the Vanderbilt Center for Health Services Research, and senior author on the study in February’s Diabetes Care.

“This is a group that is already getting treatment for type 2 diabetes, including education about exercise and nutrition. If anything, you might expect them to be more aware about weight issues. This should send up a red flag about how challenging it is to treat obesity in this population, if many of the parents and patients in this group don’t even recognize the problem.”

The parents and children were surveyed by telephone and were asked, among other things, “do you think your child’s/your weight is very overweight, slightly overweight, about right, slightly thin or very thin.”

While 87 percent of the children surveyed were obese by the most recent Centers for Disease Control and Prevention (CDC) standards, only 41 percent of parents, and 35 percent of the children reported themselves “very overweight.” Among parents who reported their child’s weight as “about right,” 40 percent had children who actually were at or over the 95th percentile for weight and were considered obese by government standards.

Girls were more likely than boys to underestimate their weight, and parents underestimated their children’s weight more often than the children did themselves. Additionally, those who underreported weight were more likely to report a poor diet and exercise than those who correctly reported their weight status. Those with misperceptions about weight also reported more barriers to better exercise and diet behaviors.

There have been other studies showing parents and children in the general population often don’t accurately perceive weight. However, Rothman said this is the first study to examine weight perception among children with type 2 diabetes — a population that should already have been informed of their weight status and its contribution to diabetes from their health care providers.

“As health care providers we need to take a step back and realize these families need better guidance about understanding their weight status before we can convince them to make lifestyle changes to improve their health,” said Rothman, who also serves as director of the Vanderbilt Program on Effective Health Communication. “We need to do a better job as providers to work on shared communication, using more clear language, goal setting with families about key behavior changes, identifying barriers and setting realistic goals.”

Diabetes Care. 2008 Feb;31(2):227-9. Epub 2007 Nov 13.
Accuracy of perceptions of overweight and relation to self-care behaviors among adolescents with type 2 diabetes and their parents.
Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7411, USA. asheley@unc.edu
OBJECTIVE: To examine how adolescents with type 2 diabetes and their parents/primary caregivers perceive the adolescents’ weight and the relationship of those perceptions to diet and exercise behaviors and perceived barriers to healthy behaviors. RESEARCH DESIGN AND METHODS: Interviews were conducted with adolescents and their parents about perceptions of the adolescents’ weight, diet, and exercise behaviors, as well as barriers to engaging in healthy diet and exercise behaviors. Interviews were linked with clinic records to provide BMI. RESULTS: A total of 104 parent-adolescent dyads participated. Parents and adolescents typically perceived the adolescents’ weight as less severe than it actually was. For parents and adolescents, underestimating the adolescents ‘ weight was associated with poorer diet behaviors and more perceived barriers to following healthy diet or exercise behaviors. CONCLUSIONS: Addressing misperceptions of weight by adolescents and their parents may be an important first step to improving weight in these patients.
for bodyweight perception in adults see:

 

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Written by huehueteotl

March 5, 2008 at 12:14 pm

Eat Until Food Is Finished Or TV-Show Is Over?

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It’s the French paradox redux: Why don’t the French get as fat as Americans, considering all the baguettes, wine, cheese, paté and pastries they eat?

Because they use internal cues — such as no longer feeling hungry — to stop eating, tells Wansink reporting a new Cornell study. Americans, on the other hand, tend to use external cues — such as whether their plate is clean, they have run out of their beverage or the TV show they’re watching is over.”Furthermore, we have found that the heavier a person is — French or American — the more they rely on external cues to tell them to stop eating and the less they rely on whether they felt full,” said senior author Brian Wansink, the John S. Dyson Professor of Marketing and director of the Cornell Food and Brand Lab in the Department of Applied Economics and Management, now on leave to serve as executive director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion until January 2009.The new study, an analysis of questionnaires from 133 Parisians and 145 Chicagoans about how they decide when to stop eating, is being published in the journal Obesity and is being presented this later month at an the Winter Marketing Educators conference.”Over-relying on external cues to stop eating a meal may prove useful in offering a partial explanation of why body mass index [a calculation based on the relationship of weight to height] varies across people and potentially across cultures,” said co-author Collin Payne, a Cornell postdoctoral researcher. He stressed that further studies should following up with smoking behavior and socio-economic differences as well. “Relying on internal cues for meal cessation, rather than on external cues, may improve eating patterns in the long term. But things are not as easy. This internality or externality of eating cues seems to have oposing effects on bodyweight, depending on where the focus of research rests (see below). The quoted study finds that dieters who have the tendency to eat in response to external factors, such as at festive celebrations, have fewer problems with their weight loss than those who eat in response to emotions (internal factors). Led by researchers at The Miriam Hospital’s Weight Control & Diabetes Research Center, the study also found that emotional eating was associated with weight regain in successful losers. So eating due to external factors and stopping meal in response to internal cues seems the right thing to do. But mind, not being hungry is the only benefic internal cue to stop eating. Who eats in response to emotional problems might well react to internal stimuli, but will be highly unlikely to keep a healthy energy-uptake with his eating habits.

Obesity (Silver Spring). 2007 Dec;15(12):2920-4.
Internal and external cues of meal cessation: the French paradox redux?
Department of Applied Economics and Management, Cornell University, 110 Warren Hall, Ithaca, NY 14853-7801, USA. Wansink@Cornell.edu
OBJECTIVE: Our objective was to investigate whether people who use internal cues of satiation when eating a meal are likely to weigh less than people who instead rely on external cues. In addition to exploring the role that internal and external cues play in meal cessation, this study raises an overlooked explanation of the French paradox. RESEARCH METHODS AND PROCEDURES: A demographically-matched student sample of 133 Parisians and 145 Chicagoans completed a brief survey on meal cessation that asked the extent to which they agreed with statements associated with internal cessation cues and statements with external cessation cues. Their answers to these were compared across BMI levels and across countries. RESULTS: Normal-weight people indicated that they were more likely to be influenced by internal cues of meal cessation (p = 0.043), while overweight people indicated that they were more influenced by external cues (p = 0.005). Similarly, while the French were influenced by internal cues of meal cessation (p < 0.001), Americans were more influenced by external cues (p < 0.001). DISCUSSION: This research revisits Schachter’s externality hypothesis and suggests that one’s over-reliance on external cues may prove useful in offering a partial explanation of why BMI might vary across people and potentially across cultures. Relying on internal cues for meal cessation, rather than on external cues, may improve eating patterns over the long term.
see also:

 

Written by huehueteotl

February 20, 2008 at 1:07 pm

Size Does Not Matter, Thinking Does…

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… at least when health prospects are concerned. In a study to examine the impact of desired body weight on the number of unhealthy days subjects report over one month, researchers at Columbia University Mailman School of Public Health found that the desire to weigh less was a more accurate predictor of physically and mentally unhealthy days, than body mass index (BMI). In addition, the desire to lose weight was more predictive of unhealthy days among Whites than among African-Americans or Hispanics, and among women than among men.

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After controlling for actual BMI and age, the researchers found that men who wished to lose 1 percent, 10 percent, and 20 percent of their body weight, respectively, reported 0.1, 0.9 and 2.7 more unhealthy days per month than those who were happy with their weight. Among women, the corresponding increase in numbers of reported unhealthy days was 0.1, 1.6 and 4.3. Persons who were happy with their weight experienced fewer physically unhealthy days (3.0 vs 3.7) and mentally unhealthy days (2.6 vs 3.6) compared with persons unhappy with their weight.

“Our data suggest that some of the obesity epidemic may be partially attributable to social constructs that surround ideal body types,” said Peter Muennig, MD, MPH, Mailman School of Public Health assistant professor of Health Policy and Management. “Younger persons, Whites, and women are disproportionately affected by negative body image concerns, and these groups unduly suffer from BMI-associated morbidity and mortality.”

Approximately 66% of the more than 150,000 U.S. adults studied wanted to lose weight, and about 26% were satisfied with their current weight. With respect to BMI, 41% of normal weight people, 20% of overweight people, and 5% of obese people were happy with their weight. Older persons were also more likely to feel positively about their weight than were younger persons. However, in all models, perceived difference was a stronger predictor than was BMI of mentally and physically unhealthy days.

The researchers emphasize that there is a large body of evidence suggesting that social stress adversely affects mental health as well as physical health. “Our findings confirmed that there was a positive relationship between a person’s actual weight and his or her desired weight and health, be it physical or mental,” observed Dr. Muennig.

Obesity is one of the greatest public health threats. Over 7 million quality-adjusted life years are lost annually as a result of excess body weight in the United States alone. There is evidence that discrimination against heavy people is pervasive, occurring in social settings, the workplace, and the home. These processes are likely internalized, leading to a negative body image that also may serve as a source of chronic stress.

“The data add support to our hypothesis that the psychological stress that accompanies a negative body image explains some of the morbidity commonly associated with being obese. Our finding that the desire to lose weight was a much stronger predictor of unhealthy days than was BMI further suggests that perceived difference plays a greater role in generating disease,” said Dr. Muennig.

Am J Public Health. 2008 Jan 30 [Epub ahead of print]
I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health.
Columbia University.

Objectives. We examined whether stress related to negative body image perception and the desire to lose weight explained some of the body mass index-health gradient. Methods. We used 2003 Behavioral Risk Factor Surveillance System data to examine the impact of desired body weight, independent of actual body mass index, on the amount of physically and mentally unhealthy days by race, ethnicity, and gender. Results. The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health. When we controlled for BMI and age, men who wished to lose 1%, 10%, and 20% of their body weight respectively suffered a net increase of 0.1, 0.9, and 2.7 unhealthy days per month relative to those who were happy with their weight. For women, the corresponding numbers were 0.1, 1.6, and 4.3 unhealthy days per month. The desire to lose weight was more predictive of unhealthy days among women than among men and among Whites than among Blacks or Hispanics. Conclusions. Our results raise the possibility that some of the health effects of the obesity epidemic are related to the way we see our bodies.

Written by huehueteotl

February 13, 2008 at 3:07 pm

Quitting Exercise May Add Pounds

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The consequences of quitting exercise may be greater than previously thought, according to a new study from the U.S. Department of Energy’s Lawrence Berkeley National Laboratory that determined that the weight gained during an exercise hiatus can be tough to shed when exercise is resumed at a later date.
A new study should prompt people to think twice before taking a break from their exercise regimens, despite the pressures of family and work obligations, or waning motivation. Weight gained during an exercise hiatus can be tough to shed when exercise is resumed at a later date. (Credit: iStockphoto)

The study, conducted by Paul Williams of Berkeley Lab’s Life Sciences Division, found that the key to staying trim is to remain active year-round, year-after-year, and to avoid seasonal and irregular exercise patterns. Most of all, don’t quit. Failure to do so may be a contributing factor in the nation’s obesity epidemic.

“The price to pay for quitting exercise is higher than expected, and this price may be an important factor in the obesity epidemic affecting Americans,” says Williams, whose study is published in the journal Medicine & Science in Sports and Exercise.

The study should prompt people to think twice before taking a break from their exercise regimens, despite the pressures of family and work obligations, or waning motivation.

Using data collected from the National Runners’ Health Study, Williams found that the impacts of increasing and decreasing vigorous exercise aren’t the same among all runners. At distances above 20 miles per week in men and 10 miles per week in women, the pounds gained by running less were about the same as the pounds lost by running more. At these exercise levels, the effects of training and quitting training are comparable, and the weight gains and losses associated with changes in exercise levels are probably reversible.

However, Williams found that people who didn’t run as many miles per week face an uphill battle if they want to lose the pounds accumulated during an exercise hiatus. At these less intense levels, an interruption in exercise produces weight gain that is not lost by simply resuming the same exercise regimen.

“At lower mileages, there is asymmetric weight gain and loss from increasing and decreasing exercise, leading to an expected weight gain from an exercise hiatus,” says Williams. “In other words, if you stop exercising, you don’t get to resume where you left off if you want to lose weight.”

Specifically, Williams compared 17,280 men and 5,970 women who decreased their running distance with 4,632 men and 1,953 women who increased their running distance over a 7.7-year period. He found that runners who decreased their distance from five to zero miles per week gained four times as much weight as those who decreased their distance from 25 to 20 miles per week. He also found that people who started running after an exercise layoff didn’t lose weight until their mileage exceeded 20 miles per week in men, and 10 miles per week in women.

Williams says his findings suggest that an effective public health policy for preventing weight gain may need to include a strategy to keep physically active people active. His study also underscores the importance of avoiding start-stop exercise patterns. Exercise designed to prevent obesity may fall short of its benefits if the exercise is irregular, seasonal, or often interrupted.

“We are getting fat because we don’t exercise sufficiently and consistently. The real solution to the obesity epidemic is getting people to exercise before they think they need it, and to stick with it,” says Williams. “The ounce of prevention is indeed worth a pound of cure.”

A study by Williams published in the same journal in August, 2007, revealed that middle-age weight gain is reduced by one-half in runners who ran 30 or more miles per week, compared to runners who ran less than 15 miles per week. These results, in conjunction with this more recent study, suggest a new way of tackling the obesity problem.

“Many scientists attribute the obesity epidemic to excess calories rather than exercise, because dieting has been shown to produce more weight loss than exercise,” says Williams. “My findings suggest that calorie intake and body weight may be self regulating in active individuals.”

Med Sci Sports Exerc. 2008 Feb;40(2):296-302.
Asymmetric weight gain and loss from increasing and decreasing exercise.

Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA.

PURPOSE: Although increases and decreases in physical activity are known to cause weight loss and weight gain, respectively, it is not known whether the magnitudes of these changes in weight are equal. Unequal (asymmetric) weight changes could contribute to overall weight gain or loss among individuals with seasonal or irregular activity. METHODS: Changes in adiposity were compared with the running distances at baseline and follow-up in men and women whose reported exercise increased (N = 4632 and 1953, respectively) or decreased (17,280 and 5970, respectively) during 7.7 yr of follow-up. RESULTS:: Per km.wk decreases in running distance caused more than four times greater weight gain between 0 and 8 km.wk (slope +/- SE, males: -0.068 +/- 0.005 kg.m; females: -0.080 +/- 0.01 kg.m) than between 32 and 48 km.wk (-0.017 +/- 0.002 and -0.010 +/- 0.005 kg.m, respectively). In contrast, increases in running distance produced the smallest weight losses between 0 and 8 km.wk and statistically significant weight loss only above 16 km.wk. Above 32 km.wk (30 kcal.kg) in men and 16 km.wk (15 kcal.kg) in women, weight loss from increasing exercise was equal to or greater than weight gained from decreasing exercise; otherwise, weight gain exceeded weight loss. CONCLUSION: Weight gained because of reductions in weekly exercise below 30 kcal.kg in men and 15 kcal.kg in women may not be reversed by resuming prior activity. Current IOM guidelines (i.e., maintain total energy expenditure at 160% of basal) agree with the men’s exercise threshold for symmetric weight change with changing exercise levels. Asymmetric weight changes below this threshold may contribute to weight gain among less-active subjects.

Written by huehueteotl

February 11, 2008 at 9:51 am

Let Us Eat And Drink; For To Morrow We Shall Die.

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At least Isaiah xxii. 13 (AV) has it like this.

https://i0.wp.com/www.allaboutarchaeology.org/images/great-isaiah-scroll.jpgAnd he did not know that overweight smokers are an even less financial burden for public health. They simply die soonest, causing the least cost in health care systems.

A new research paper suggests that preventing obesity might result in increased public spending on medical care. Many countries are currently developing policies aimed at reducing obesity in the population. However, it is not currently clear whether successfully reducing obesity will also reduce national healthcare spending or not. Pieter van Baal and colleagues, from the National Institute for Public Health and the Environment in the Netherlands, created a mathematical model to try to answer this question.

In their study, van Baal and his co-workers created three hypothetical populations of 1000 men and women, all aged 20 years at the start: a group of obese, never-smoking individuals; a group of healthy-never smoking individuals of normal weight; and a group of smokers of normal weight. The model produced an estimate of the likely proportion of each group who would encounter certain long term (chronic) diseases, and then estimated what the approximate cost of medical care associated with each disease was likely to be. The researchers found that the group of healthy, never-smoking individuals had the highest lifetime healthcare costs, because they lived the longest and developed diseases associated with aging; healthcare costs were lowest for the smokers, and intermediate for the group of obese never-smokers.

However, the authors argue that although obesity prevention may not be a cure for increasing expenditures, it may well be a cost-effective cure for much morbidity and mortality and importantly contribute to the health of nations.

Should Isaiah’s biblical ammendment be then. “Eat, drink, smoke and be merry, for tomorrow we diet”? Mind, this is a mathematical model comparing life-time-health-costs. Main target of medicine is not keeping public health cheap but people healthy until old age! A Perspective by Klim McPherson, from Oxford University in the UK, who was not involved in the study, discusses the implications of these findings and comments that “it would be wrong to interpret the findings as meaning that public-health prevention (e.g., to prevent obesity) has no benefits”; the quality of life experienced by individuals, and other factors, must also be taken into account when planning interventions aimed at improving public health.

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van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008)

Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure.

PLoS Med 5(2): e29. doi:10.1371/journal.pmed.0050029

BackgroundObesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.

Methods and Findings

With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.

Conclusions

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

Written by huehueteotl

February 7, 2008 at 4:23 pm

Seasonal Changes in Mood and Behavior Are Linked to Obesity

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Obesity is a public health problem worldwide, officials even using the term of an obesity epidemic. Meanwhile, it is increasingly accepted that obesity is a consequence of combined genetic and environmental factors. A new finnish study could pove that a defective circadian clockwork is associated with obesity and metabolic syndrome.

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8028 individuals attended a nationwide health examination survey in Finland. Participants were assessed  for metabolic syndrome and for their seasonal changes in mood and behavior. Seasonal changes in weight in particular were a risk factor of metabolic syndrome, after controlling for a number of known risk and potential confounding factors.

“Abnormalities in the circadian clockwork which links seasonal fluctuations to metabolic cycles may predispose to seasonal changes in weight and to metabolic syndrome”, the researchers explain.

Rintamäki R, Grimaldi S, Englund A, Haukka J, Partonen T, et al. (2008)

Seasonal Changes in Mood and Behavior Are Linked to Metabolic Syndrome.

PLoS ONE 3(1): e1482. doi:10.1371/journal.pone.0001482

Background

Obesity is a major public health problem worldwide. Metabolic syndrome is a risk factor to the cardiovascular diseases. It has been reported that disruptions of the circadian clockwork are associated with and may predispose to metabolic syndrome.

Methodology and Principal Findings

8028 individuals attended a nationwide health examination survey in Finland. Data were collected with a face-to-face interview at home and during an individual health status examination. The waist circumference, height, weight and blood pressure were measured and samples were taken for laboratory tests. Participants were assessed using the ATP-III criteria for metabolic syndrome and with the Seasonal Pattern Assessment Questionnaire for their seasonal changes in mood and behavior. Seasonal changes in weight in particular were a risk factor of metabolic syndrome, after controlling for a number of known risk and potential confounding factors.

Conclusions and Significance

Metabolic syndrome is associated with high global scores on the seasonal changes in mood and behavior, and with those in weight in particular. Assessment of these changes may serve as a useful indicator of metabolic syndrome, because of easy assessment. Abnormalities in the circadian clockwork which links seasonal fluctuations to metabolic cycles may predispose to seasonal changes in weight and to metabolic syndrome.

Written by huehueteotl

February 7, 2008 at 12:50 pm

Obesity Wired In The Brain?

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A predisposition for obesity might be wired into the brain from the start, suggests a new study of rats.

Rats selectively bred to be prone to obesity show abnormalities in a part of the brain critical for appetite control, the researchers found. Specifically, the researchers show that the obese rats harbor defects in neurons of the arcuate nucleus (ARH) of the hypothalamus, which leaves their brains less responsive to the hunger-suppressing hormone leptin.

“The neurodevelopmental differences in these animals can be seen as early as the first week,” said Sebastien Bouret of the University of Southern California. “The results show that obesity can be wired into the brain from early life. The three-million-dollar question now is how to get around this problem.”

It is increasingly accepted that obesity results from a combination of genetic and environmental factors, the researchers said. Rodent models of obesity can provide valuable insights into the biological processes underlying the development of obesity in humans. The “diet-induced obese” (DIO) rats used in the current study are particularly suited to the task, according to Bouret, because their tendency to become overweight shares several features with human obesity, including the contribution of many genes.

A predisposition for obesity might be wired into the brain from the start, suggests a new study. (Credit: iStockphoto/Ekaterina Monakhova)

Previous studies had suggested that the brains of DIO rats are insensitive to leptin, the researchers added. Circulating leptin, produced by fat tissue, acts as a signal to the brain about the body’s energy status. Leptin is also critical for the initial development of ARH neurons.

In the new study, the researchers examined the obesity-prone rats for signs of abnormal brain development. They found that the animals’ brains had fewer neural projections from the ARH, a deficiency that persisted into adulthood. Those projections are needed to relay the leptin signal received by the ARH to other parts of the hypothalamus, Bouret said.

The researchers found further evidence that those changes in brain wiring stem from a reduced responsiveness of the brain to leptin’s action during development.

“It seems [in the case of these rats] that appetite and obesity are built into the brain,” Bouret said. While their condition might be ameliorated by exercising and eating right, he added, the findings suggest that the propensity to gain weight can’t be reversed.

But there is hope yet. It’s possible that treatments delivered during a critical early period of development might be capable of rewiring the brain, Bouret said.

Cell Metab. 2008 Feb;7(2):179-85.
Hypothalamic neural projections are permanently disrupted in diet-induced obese rats.
Neuroscience Program, The Saban Research Institute, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA; Inserm, U837, Jean-Pierre Aubert Research Center, Université Lille 2, 59045 Lille, France.The arcuate nucleus of the hypothalamus (ARH) is a key component of hypothalamic pathways regulating energy balance, and leptin is required for normal development of ARH projections. Diet-induced obesity (DIO) has a polygenic mode of inheritance, and DIO individuals develop the metabolic syndrome when a moderate amount of fat is added to the diet. Here we demonstrate that rats selectively bred to develop DIO, which are known to be leptin resistant before they become obese, have defective ARH projections that persist into adulthood. Furthermore, the ability of leptin to activate intracellular signaling in ARH neurons in vivo and to promote ARH neurite outgrowth in vitro is significantly reduced in DIO neonates. Thus, animals that are genetically predisposed toward obesity display an abnormal organization of hypothalamic pathways involved in energy homeostasis that may be the result of diminished responsiveness of ARH neurons to the trophic actions of leptin during postnatal development.

 

Written by huehueteotl

February 7, 2008 at 9:52 am